Workers Comp Claims Representative

About the role

Elevate Patient Financial Solutions is seeking a detail-oriented and proactive Workers Compensation Claims Representative to join our team. This remote, full-time opportunity offers a consistent schedule of Monday - Friday hours to be determined with manager at time of offer. In 2024, our Workers Compensation department resolved over 175,000 claims on behalf of our hospital clients and their patients.

Responsibilities

• Maintain a queue of Workers’ Compensation accounts as assigned by management.
• Contact patient’s employer, Workers’ Compensation carrier, and injured worker via telephone and mail to obtain injury information and insurance information.
• Support patients by answering any questions about the Workers’ Compensation process.
• Cookordinate with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.
• Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.
• Perform manual data entry of patient accounts and/or claim forms.
• Submit hospital and physician bills to insurance companies for payment.
• Maintain contact with insurance adjusters/carriers, employers, and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.
• Obtain claim status and gather supporting documentation to submit appeals.
• Make written or verbal appeals to payers on denied claims.
• Provide strong customer service to clients and provide responses to client inquiries within 24 hours.
• Provide detailed updates to Elevate PFS’s account management system and hospital/provider practice management system as account work is completed.
• Aid in training both new and existing employees, which may include contributing specific training material.
• Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively.
• Identify and discuss root cause issues with management.
• Maintain and updates proper account documents in multiple systems.
• Aid in ad hoc inventory initiatives and other projects, as needed.
• Review and manage patient accounts to ensure that proper documentation, payments, and necessary letters of authorization are entered correctly.
• Maintain and adhere to compliance policies and procedures.

Qualifications and Requirements

• High School Diploma or GED
• Some college coursework preferred
• Positive and encouraging attitude
• Strong customer service background
• Professional, accurate, clear, and concise communication, both verbal and written, including the ability to write routine business correspondence
• Detailed and thorough
• Adaptable
• Organized and excel in time management
• Ability to manage and move quickly and accurately through a large workload
• Prominent ability to be assertive in order to proactively resolve issues
• Demonstrated ability to organize and set priorities according to changing situations and demands
• Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications
• 1-5 years of related experience in the field or in a related area such as: Medical billing and coding, Medical appeals, Claims Adjudication, Insurance, Workers’ Compensation, Legal work